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Asim Kurjak

Publications and source records attributed to Asim Kurjak.

At least 37 records · Page 2Linked to original sources
PubMed2003

Three-dimensional ultrasonographic ovarian measurements and in vitro fertilization outcome are related to age.

OBJECTIVE: To evaluate whether the number of ovarian antral follicles, ovarian volume, and ovarian stromal blood flow change with age and to prospectively analyze whether three-dimensional ultrasonographic measurements predict ovarian response and IVF outcome. DESIGN: Prospective analysis. SETTING: Assisted reproductive unit. PATIENT(S): Fifty-six consecutive women 22 to 43 years of age with normal basal serum FSH concentrations who were undergoing their first IVF cycle. MAIN OUTCOME MEASURE(S): Number of ovarian antral follicles, ovarian volume, and ovarian stromal flow index were determined by three-dimensional and power Doppler ultrasonography. Pretreatment measurements were compared with number of recovered oocytes, fertilization rates, and pregnancy rates. RESULT(S): As patient age increased, significant trends in ovarian volume, number of follicles, and stromal vascularity decreased. Three-dimensional ovarian measurements and fertilization rates differed significantly among age groups. For each age group, a higher number of antral follicles, greater ovarian volume, and favorable ovarian stromal vascularity was associated with higher number of retrieved oocytes and increased pregnancy rates. CONCLUSION(S): Increasing patient age is associated with poor ovarian response, as represented by smaller ovarian volume, lower antral follicle count, and poor stromal vascularity. Three-dimensional power Doppler ultrasonography can help to individualize IVF in patients regardless of age.

Adult↗
PubMed2003

The detection of stage I ovarian cancer by three-dimensional sonography and power Doppler.

OBJECTIVE: The objective was to determine the diagnostic accuracy of three-dimensional (3D) sonography and 3D power Doppler imaging, used together with standard 2D transvaginal grayscale and color/power Doppler modalities, for preoperative sonographic assessment of suspected ovarian lesions. METHODS: Five-year retrospective analysis was performed by our experts on ultrasonography and surgery on the reports from 43 referred patients with suspected stage I ovarian cancer. All patients were evaluated during the week prior to surgery at our department. Preoperative sonographic assessment included careful examination of ovarian volume, morphology, and vascularity by four complementary sonographic methods. Scoring systems combining morphological and Doppler parameters were adopted for 2D and 3D sonographic examinations. Final diagnosis was confirmed by a histopathologist. RESULTS: Out of the 43 stage I ovarian cancers, 42 cases were successfully detected preoperatively by four complementary sonographic methods. Only 30 (69.8%) and 37 (86.1%) cases of stage I ovarian cancer were detected by 2D grayscale and combined 2D grayscale and color Doppler sonography, respectively. Morphological analysis obtained by 3D sonography alone detected 32 of 43 ovarian malignancies, reaching a diagnostic rate of 74.4%. Qualitative analysis of tumor vascularity architecture by 3D power Doppler significantly improved the sonographic management process and successfully detected 41 cases of stage I ovarian cancer (95.4%). When morphological features obtained by 3D sonography were added to 3D power Doppler findings, we achieved an even higher diagnostic accuracy of 97.7%. We found a statistically significant difference (P </= 0.01) in diagnostic rates of 3D power Doppler, and especially the combined use of 3D sonography and 3D power Doppler in comparison to those obtained with transvaginal 2D grayscale (P </= 0.002 and P </= 0.001, respectively) or 3D sonography (P </= 0.006 and P </= 0.002, respectively). CONCLUSIONS: In comparison to transvaginal 2D grayscale or 3D sonography, 3D power Doppler and especially the combined use of 3D sonography and power Doppler imaging significantly improve diagnostic accuracy in preoperative sonographic assessment of suspected ovarian lesions.

Female↗
PubMed2003

The Misgav Ladach method--a step forward in operative technique in obstetrics.

AIM: To investigate the advantage of performing cesarean section using the Misgav-Ladach method and to justify its use in everyday practice. METHODS: In a prospective study we analyzed over a two year period (2000-01) cesarean sections carried out using the Misgav-Ladach method at our clinic. We compared both 550 cases of Misgav-Ladach (ML) and 100 cases of Pfannenstiel (PH) cesarean section. In the group that had undergone the Misgav-Ladach method we sutured the uterus in one layer and left the peritoneum non-sutured, and in the group who had undergone Pfennenstiel we sutured the uterus in two layers and also sutured the visceral and parietal peritoneum. In every case we analyzed: maternal age, gestational age, duration of operation, consumption of suture material, duration of hospitalization, and surgical complications. RESULTS: Incidence of postoperative febrile morbidity was 5.45%, in the Misgav-Ladach group compared with 13.2% in the Pfannenstiel group (p < 0.05). Local infection of the wound in the Misgav-Ladach group was found in 4.54% and in the Pfannenstiel group in 9% (p < 0.05). Mean time of extraction of the newborn in the Misgav-Ladach group was 1.25 minutes, and in the Pfannenstiel group 4.10 minutes (P < 0.05). Mean duration of operation in the Misgav-Ladach group was 10.98 min, and in the Pfannenstiel group 25 min (p < 0.05). Mean duration of hospitalization in the Misgav-Ladach group was 4.75 days, and in the Pfannenstiel group 6.32 days (p > 0.05). Mean consumption of suture material in the group Misgav-Ladach was 3.10 sutures per operation, and in the Pfannenstiel group was 9.5 sutures. CONCLUSION: Our study shows that the Misgav-Ladach method of cesarean section enables fast recovery and shorter hospitalization, and reduces the length of the operation, the incidence of surgical complication and the consumption of surgical materials.

Adolescent↗
PubMed2003

Fetal hand movements and facial expression in normal pregnancy studied by four-dimensional sonography.

AIM: To evaluate the developmental pattern of fetal hand movements and facial activity and expression during the second and third trimester of pregnancy by four-dimensional ultrasound (4D-US). SUBJECTS AND METHODS: A total of 25 fetuses in uncomplicated pregnancies were analyzed; 15 fetuses at 13 to 16 weeks and 10 fetuses at 30 to 33 weeks of gestation were studied with abdominal 4D-US. After standard assessment in two dimensional (2D) real-time B mode, a 4D mode was switched on. Further examination lasted a maximum of 15 minutes. RESULTS: Isolated hand movement and subtypes of hand movements were easily recognized by 4D-US. The sub-types of hand to head movement are: hand to head, hand to mouth, hand near mouth, hand to face, hand near face, hand to eye and hand to ear. All subtypes of hand to head movement can be seen from 13 weeks of gestation, with fluctuating incidence. Facial activities and different forms of expression are easily recognized by 4D-US. Among these, two types can be easily differentiated: smiling and scowling. CONCLUSIONS: 4D-US is superior over real-time two-dimensional ultrasound (2D-US) for qualitative, but inferior for quantitative analysis of hand movements. Thus 4D-US makes it possible to determine exactly the direction of the fetal hand, but the exact number of each type of hand movements can still not be determined. 4D-US is superior over two- and three-dimensional sonography in the evaluation of complex facial activity and expression. Among facial activities observed by 4D-US, simultaneous eyelid and mouthing movements dominate between 30 and 33 weeks of gestation. Pure mouth movements such as mouth opening, tongue expulsion, yawning and pouting are present, but at a significantly lower incidence. Facial expressions such as smiling and scowling can be precisely observed using 4D-US.

Facial Expression↗
PubMed2003

[The story of angiostatin and how controversy is useful in science].

Angiogenesis is the formation of new capillary blood vessels. It has a very important role not only in physiological conditions but also in the process of malignant human growth. Latest data suggesting that drugs inhibiting angiogenesis can stop the growth of malignant tumors have made the research on tumorous angiogenesis a hot topic recently. The pioneers in the field of angiogenesis, Judah Folkman and his team, have been challenged ever since they began the research. Several articles questioned the effectiveness of systemic gene therapy with anglostatin as an anticancer treatment in a mouse model of transduced hematopoletic stem cells. In a recent issue of Nature Medicine, Folkman has elegantly answered all the difficult questions of his criticizers showing impressively how criticism and controversies in scientific work represent the main generator of new ideas.

Angiogenesis Inhibitors↗
PubMed2003

Monochorionic twin pregnancy: retrospective analysis of predicted pregnancy outcome.

AIM: To assess the accurate establishment of chorionicity, perinatal complications, and outcome of monochorionic twin pregnancies managed in a tertiary referral center in Croatia and compare the findings with data published for other countries. METHODS: The retrospective analysis included data on a total of 24 monochorionic twin pregnancies delivered at the Department between January 1998 and May 2002. The data retrieved from the maternity ward birth register included the ultrasound establishment of chorionicity, demographic data, complications of the pregnancy (presence of twin-to-twin-transfusion syndrome, intrauterine growth restriction, and threatened or actual preterm labor rate), and pregnancy outcome. Perinatal morbidity and mortality were also analyzed. RESULTS: The establishment of chorionicity by ultrasound was accurate in all 24 monochorionic twin pregnancies. Five twins died in the perinatal period, and two in early neonatal period. The median gestational age at delivery was 35 weeks, ranging 29 to 38 weeks, and median birth weight was 1,990 g, ranging from 740 to 3,000 g. Intrauterine growth restriction was present in 18 cases, whereas twin-to-twin-transfusion syndrome complicated 2 monochorionic twin pregnancies. Symptoms of threatened preterm labor were present in 19 women, whereas actual preterm delivery rate was 16 out of 24. CONCLUSION: The diagnosis of monochorionic twin pregnancy can be reliably made by ultrasound. Monochorionic twin pregnancies are characterized by a high complication rate, with threatened and actual preterm labor and delivery as the most common complications. These pregnancies are also accompanied with high perinatal mortality and morbidity.

Adult↗
PubMed2002

In vitro fertilization in spontaneous cycles--our experience.

OBJECTIVE: To study the efficacy of a simple protocol of natural cycle in vitro fertilization. METHOD: A retrospective study of 59 natural treatment cycles in 37 infertile couples with previous unsuccessful attempts of conventional in vitro fertilization. RESULTS: In 24% of cycles, the aspiration was cancelled because of inadequate visualization of follicles or because of preterm ovulation. Aspiration was performed in 45 cycles with oocyte retrieval of 82% per aspiration. Embryo transfer was performed in 30 cycles, pregnancy rate per pick-up was 15%. CONCLUSION: In vitro fertilization in a natural cycle is a simple, relatively cheap and comfortable procedure with reasonable results and can be offered to patients scheduled not only for in vitro fertilization because of tubal factor but also to patients with endometriosis or unexplained infertility.

Embryo Transfer↗
PubMed2002

Ultrasonic assessment of the peri- and postmenopausal ovary.

OBJECTIVE: To analyze the role of B-mode ultrasound, color and power Doppler examination and three-dimensional ultrasound with and without power Doppler facilities in evaluation of the peri- and postmenopausal ovaries. METHODS: Review of the literature on ultrasonic assessment of the ovaries in postmenopausal patients. RESULTS: Ultrasound has assumed an increasing role in the evaluation of the peri- and postmenopausal ovaries. Ovarian lesions are a cause of great concern because of their malignant potential and the limited ability to distinguish accurately between benign and malignant lesions using morphological sonographic criteria alone. Superimposed color Doppler imaging enables the visualization of vascularization and blood flow characteristics of the ovaries and/or ovarian lesions. It becomes possible to detect normal, suspicious and pathologic blood flow characteristics even in small blood vessels. Owing to superb quality of the images, three-dimensional sonography enables precise assessment of the ovarian lesions. Three-dimensional power Doppler ultrasound permits effective targeting and rendering of ovarian tumor vasculature, thus providing new diagnostic possibilities for early detection of ovarian malignancy and differentiation of benign from malignant ovarian pathology. CONCLUSIONS: Further technological development will contribute to more objective evaluation of ovarian tumor morphology and vasculature which will give us tremendous support in clinical decision making and planning the management.

Female↗
PubMed2002

Ultrasonic assessment of the postmenopausal uterus.

OBJECTIVES: To assess the role of different forms of ultrasound in the evaluation of peri- and postmenopausal uterus. METHODS: B-mode ultrasound, colour and pulsed Doppler sonography, three-dimensional ultrasound and three-dimensional power Doppler sonography are non-invasive tools used repeatedly for assessing morphology and vascularity of the uterus and uterine lesions in peri- and postmenopausal patients. RESULTS: The application of transvaginal colour Doppler to the peri- and postmenopausal patients for the screening for endometrial and myometrial malignancy may be a viable option if combined with ovarian screening in the same scan. In this way the capital costs would be shared and oncological preventive medicine for postmenopausal women could be initiated. Three-dimensional and power Doppler ultrasound offers improved visualisation of uterine lesions, displays an entire volume, offers accurate volume estimation and enables retrospective review of stored data. Interactive rotation of power Doppler rendered images provides improved visualisation of the uterine vasculature. CONCLUSIONS: Further technological development of the ultrasound imaging techniques could result in reduction of both the potential risks and economic cost of the invasive diagnostic procedures in postmenopausal patients such as dilatation and curettage operations. Same techniques can be used for early detection of endometrial malignancy in asymptomatic postmenopausal women as well as for prediction of the depth of myometrial invasion.

Endometrial Neoplasms↗
PubMed2002

Evaluation of serum CA 125 concentration before and during hormonal induced cycles as predictor of IVF/ET outcome.

PROBLEM: To evaluate the role of CA 125 in prediction of in vitro fertilization and embryo transfer (IVF/ET) outcome. METHOD OF STUDY: Serum CA 125 concentrations were evaluated in the spontaneous and stimulated cycles of 33 patients. CA 125 was measured using a microparticle enzyme immunoassay (MEIA) (Abbott, Diagnostics, USA). Follicular growth, endometrial thickness and subendometrial blood flow were evaluated by transvaginal color Doppler ultrasound. Statistical analysis was performed by Wilcoxon rank-sum test and Friedman test. RESULTS: There was no statistically significant difference (P > 0.05) of CA 125 values between spontaneous and stimulated cycles, and between pregnant and non-pregnant patients. A CA 125 rise from the late proliferative to the early secretory phase (P < 0.05) was obtained only in the stimulated cycles. There was no relationship between CA 125, follicle number, endometrial thickness and resistance index of the subendometrial vessels. CONCLUSION: CA 125 levels are not predictive of ovarian and endometrial response. Hormonal stimulation does not effect serum CA 125 concentration. There was no influence of CA 125 levels on IVF/ET outcome in stimulated cycles.

Adult↗
PubMed2002

Screening for uterine abnormalities by three-dimensional ultrasound improves perinatal outcome.

The main goal of our study was to assess the true incidence of surgically correctable uterine abnormalities (congenital uterine anomalies, submucous leiomyoma, endometrial polyps and intrauterine synechiae) in the infertile population attending our tertiary infertility clinic. All of the infertile patients enrolled in the study were evaluated by three-dimensional ultrasound. Another objective was to assess pregnancy rates before and after operative hysteroscopy in patients affected by uterine causes of infertility. Good quality 3D images were obtained in all 3850 infertile patients, and in 23.2% of them 3D US revealed surgically correctable uterine abnormalities. The incidence of uterine septum in our general infertile population was 17.9%. Uterine septum was the most common uterine abnormality accounting for 77.1% of the intracavitary lesions. Out of 310 patients that were followed-up, 225 (72.6%) patients achieved pregnancy. The rate of term deliveries after septal incision was 57.7%, while 15.4% of patients had preterm deliveries. The rate of spontaneous abortions dropped from 41.7% before, to 11.9% after hysteroscopic resection of the septum. Three-dimensional ultrasound can be used as a screening method for detection of uterine abnormalities in patients suffering from infertility. We found significant improvement in reproductive outcome after operative hysteroscopy in secondary infertile patients with septate uterus and/or other uterine abnormalities.

Female↗
PubMed2002

Three-dimensional power Doppler in study of embryonic vasculogenesis.

Three-dimensional power Doppler sonography plays an important role in obstetrics, predominantly for assessing the relationship between fetal vascular system and surrounding organs. Presenting volume data in a standard anatomic orientation is valuable for assisting both ultrasonographers and pregnant patients to recognize anatomy more readily. This investigation was designed as an observational cross-sectional study. A group of 25 patients in gestational age of five to eleven weeks were recruited for the study. Architecture of the embryonic vessels was depicted by 3D power flow mapping and analyzed visually. Vascular 3D measurements were done through 3D color/power histogram and expressed by Vascularization Index (VI) and Vascularization Flow Index (VFI). Volume of the embryo increased exponentially throughout the observation period. The VI and VFI showed no change despite an exponential growth of embryonic volume. The findings of our study suggest that in cases of physiologic embryonic vasculogenesis there is a homeostatic steady state between tissue demands and blood supply given through the vascular network.

Embryo, Mammalian↗
PubMed2002

The assessment of placental blood vessels by three-dimensional power Doppler ultrasound.

OBJECTIVE: This study was performed in order to compare the performance of classical two dimensional (2D) and three dimensional (3D) ultrasound, both with power Doppler technology, in the visualization of the placental vascular network during ongoing pregnancy. METHODS: 15 pregnant volunteers in the third trimester of pregnancy were examined by 2D and 3D power Doppler ultrasound. The aim of the study was to follow the branching of the main stem vessel as far as possible distally in the placenta. In addition, we assessed the visualization rate of terminal parts of uteroplacental circulation, radial and spiral arteries. RESULTS: There was no difference in the visualization of primary placental stem vessels by 2D and 3D power Doppler. However, 3D power Doppler performs better distally, with statistically significant differences at the level of secondary stem (p = 0.03), and even more prominent differences at the level of tertiary stem vessels (p = 0.0008). There was no difference in the visualization rate of radial and spiral arteries (p > 0.05). CONCLUSION: We found 3D superior to 2D ultrasound with power Doppler technology in the determination of the distal vascular branches of the fetal placental blood vessels.

Female↗
PubMed2002

Assessment of early chorionic circulation by three-dimensional power Doppler.

Three-dimensional power Doppler sonography is a unique instrument that enables assessment of vascular signals within the whole investigated area. Hemodynamical changes included in the process of early placentation are one of the most exciting topics in investigation of early human development. This investigation was designed as an observational cross-sectional study. A group of 25 patients in gestational age five to eleven weeks were recruited for the study. After acquirement of the volume containing three-dimensional power Doppler data of the pregnant uterus, the signals belonging to the chorion were isolated. Vascular 3D measurements were undertaken through 3D color/power histogram and expressed by Vascularization Index (VI) and Vascularization Flow Index (VFI). Volume of the chorion increased exponentially throughout the observation period. The VI and VFI positively correlated with the crown-rump length and chorion volume, and showed gradual increment through the investigation period. This investigation produced results confirming gradual augmentation of the loci and intensity of the intervillous flow in pregnancies between five and eleven gestational weeks.

Chorion↗
PubMed2002

Limb deformities and three-dimensional ultrasound.

AIM: To assess the ability of three-dimensional (3D) ultrasonography for improvement of antenatal detection of limb deformities. METHODS: 347 patients were selected from a routine outpatient clinic or sent for supervision from other units because of suspected anomalies of fetal extremities. 3D ultrasound devices used in the study were Combison 530D and Voluson 530D MT (Kretztechnik, Zipf, Austria) with a 3-5 MHz annular array transducer for three-dimensional volume scanning. RESULTS: In 41 of 347 patients the initial diagnosis was suspected by two-dimensional sonography (gestational age 18-32 weeks). In 28 of 41 suspected cases the diagnosis of abnormalities was determined after examination by 3D sonography: 17/28 clubfoot, 3/28 hand-polydactily, 2/28 upper limb contractures, 1/28 lower limb contractures, 4/28 micromelia within the syndrome of skeletal dysplasia. In 13 of 41 suspected cases, normal anatomy was confirmed using 3D sonography. CONCLUSION: Three-dimensional sonography is the "method of choice" for the detection of an isolated defect of a single limb, developmental or positional deformations and minor defects of hands and feet. Surface-mode reconstruction of the complete limb and transparent-view reconstruction of the entire skeletal structure are effective technical advantages enabling a completely new visual perception of the unborn baby.

Clubfoot↗